To accompany the release of Opening Doors, as amended in 2015, we will be taking a closer look at each of the four key updates to the document this week. We’ll be sharing comments from partners, community members, and the USICH staff on how the updates are impacting their daily work, helping to prevent and end homelessness across America, as well as highlight the key changes around the updated topic.

Spotlight on Changing of the Goal of Ending Chronic Homelessness

“The national goal and deadline for ending chronic homelessness set by Opening Doors enabled states like Utah to generate the momentum and energy needed to achieve our goal. And if Utah can do it, anyone can do it. Moving the target date for ending chronic homelessness in 2017 still gives states, counties, and cities the hard deadline they need to cultivate champions and re-purpose existing resources, while securing additional resources needed to achieve the goal.

Among people experiencing homelessness, there is a subset of individuals who experience homelessness for long periods of time, and/or in repeated episodes over many years—people experiencing chronic homelessness. These men and women commonly have a combination of challenges including mental health problems, substance use disorders, and complex health conditions that worsen over time and often lead to an early death. Studies have found that people experiencing chronic homelessness cost the public between $30,000 and $50,000 per person per year through their repeated use of emergency rooms, hospitals, jails, psychiatric centers, detox and other crisis services, the use of which make little improvements to their health and well-being. Given the cost it bears in human lives and public dollars, ending chronic homelessness is a moral and fiscal imperative.

The solution to end chronic homelessness is permanent supportive housing, which combines affordable housing with tailored, supportive services. This combination of housing and support helps people achieve housing stability, connections to care, and improved health and social outcomes.

On any given night, we know that nearly 85,000 Americans with disabling health conditions who have experienced homelessness for long periods of time—some for years or decades—can be found sleeping on our streets, in shelters, or other places not meant for human habitation. These men and women experiencing chronic homelessness commonly have a combination of mental health problems, substance use disorders, and medical conditions that worsen over time and too often lead to an early death.

Without connections to the right types of care, people who are experiencing chronic homelessness cycle in and out of hospital emergency departments and inpatient beds, detox programs, jails, prisons, and psychiatric institutions—all at high public expense. Some studies have found that leaving a person to remain chronically homeless costs taxpayers as much as $30,000 to $50,000 per year.

Five years since the passage of the Affordable Care Act, many of the major objectives of the law are being met; more than 16 million Americans have gained health coverage, bringing the number of people without insurance down to historic lows. Included in the newly insured are approximately six million of the lowest income Americans, who have gained access to public health insurance through Medicaid and the Children’s Health Insurance Program (CHIP). And while the data is limited on the specific number of people experiencing homelessness who have gained coverage, we have numerous reports that enrollment in Medicaid and other types of health insurance among people experiencing homelessness has grown significantly. With so many people now able to access health care coverage, the results are in: the Affordable Care Act is working.

Of course, increasing access to health coverage is only one objective of the law. The other major objective is to shift the focus of health care away from procedures and treatments and towards the overall quality of care and people’s health outcomes. For people who experience homelessness, we know that having stable housing is essential to health. Stable housing not only has direct benefits on health—reducing exposure to high-risk behaviors and the negative effects of life on the streets—but it also creates a platform for better care. Thus, for people experiencing homelessness, the ultimate measure of whether or not the Affordable Care Act is working may be the degree to which it can incentivize the health care system to address housing needs as a foundation for better health.

It has been proven time and time again that for people experiencing chronic homelessness and suffering from chronic health conditions, the path to improved health begins with stable housing, namely through supportive housing. Supportive housing (also known as ‘permanent supportive housing’) has been shown to improve physical and behavioral health outcomes for people experiencing chronic homelessness, while simultaneously lowering health care costs by decreasing emergency room visits and hospitalizations. In most communities today however, the services that make supportive housing so effective are still funded by a patchwork of public and private sources, or in some cases, are severely under-funded. Fortunately, thanks to the Affordable Care Act we now have the potential to create a more systematic and sustainable way to finance services in supportive housing -- through Medicaid.

The truth is, this isn’t all new. Medicaid has covered these types of supportive housing services for a long time. After all, one of Medicaid’s first authorities allowed states to cover primary care case management. What is new is the Affordable Care Act, which by increasing the coverage of people experiencing homelessness under Medicaid and by shifting the focus of health care on value rather than volume, creates new opportunities to increase the role of Medicaid in covering services in supportive housing. At the same time, Medicaid is a Federal and state program and the decision to cover these services under Medicaid rests with the states. Whether states do so will depend on the degree to which they are made aware of the cost-benefit of helping people access and obtain housing as opposed to cycle in and out of emergency rooms, inpatient hospital beds, shelters, and the streets.

We all have the responsibility of educating states about the cost-effectiveness of supportive housing and the opportunity to cover services in supportive housing under Medicaid. Here are four things you can do to ensure your state includes these services:

Sonia Niznik (pictured right, with her Case Manager, Rudy Trinidad) was taking shelter from Arizona’s dry summer heat at a “cooling center” provided by a local church when a team of outreach workers began conducting screenings using the Vulnerability Index-Service Prioritization and Decision Assistance Tool (VI-SPDAT). At the time, Sonia had been without a home for about three years.

Sonia’s interview was part of the first wave of VI-SPDAT assessments conducted for Tucson’s Coordinated Entry pilot. The Coordinated Entry system is designed to prioritize and assist Veterans and chronically homeless individuals based on their level of vulnerability and embraces a “housing first” philosophy, operating with harm reduction principles within the safe environment of a home.

Sonia was the first individual matched with housing under the new system. To date, more than 80 Veterans and chronically homeless individuals have been matched with housing and about 15 clients have been able to move into permanent housing through this system.

I, Rudy Trinidad, a Housing Navigator and Case Manager for the Pasadera Behavioral Network, met Sonia a week and a half after she filled out the VI-SPDAT. When I met her, she had a big smile on her face. She was amazed that she was contacted about permanent supportive housing (PSH) so quickly after completing the survey. I helped her prepare the documentation she needed to qualify for the Pasadera PSH program, which is funded through the Department of Housing and Urban Development (HUD) Continuum of Care. She chose a place in a recovery based living community to help her address her substance use issues, which contributed to the job loss that led to her homelessness. A few weeks later, she had her own fully furnished studio apartment.

The U.S. Department of Housing and Urban Development’s Office of Community Planning and Development, the U.S. Department of Health and Human Services’ Administration for Children and Families and the Substance Abuse and Mental Health Services Administration, and U.S. Department of Veteran Affairs’ Veteran Health Administration have recently announced a Memorandum of Understanding (MOU) that sets forth shared understanding of each agency’s respective roles and responsibilities regarding the use of Homeless Management Information Systems (HMIS).

We know that using data to make smart decisions drives improvement in results. The more effectively we can collect, analyze, share, and coordinate around a common set of data, the more effectively we can inform action to end homelessness. For most communities, Homeless Management Information Systems (HMIS) are the primary data systems to capture information about families, youth, and individuals experiencing homelessness as well as information about the provision of housing and services to homeless individuals and families and persons at risk of homelessness.

HMIS helps us not only understand the impact our programs are having, it helps us better understand who our programs are engaging and how effective that engagement is. Action is underway now at the Federal level to integrate and align HMIS across Federal programs, which will help break down silos between services and programs and improve the effectiveness of our services and programs.

Much of my passion for ending homelessness comes from my time on the front-lines where I worked to connect very vulnerable people – adults with disabling conditions who had often spent years without a safe and stable place to call home – to permanent supportive housing. Even in my small city, there were times when units were not available for people who needed them the most. We simply didn’t have enough permanent supportive housing units, and even the units that we had were not always being targeted to people experiencing chronic homelessness. We know that this is too often the case in many communities across the country.

The Obama Administration is committed to ending chronic homelessness nationally in 2017. Achieving this goal nationally is only possible if we achieve it locally. To do so, communities across the country must have enough available permanent supportive housing units to serve people currently experiencing chronic homelessness and to prevent people with disabling conditions from becoming chronically homeless in the future.

A critical first step to achieving our shared goal is to determine the specific combination of strategies needed to increase the availability of permanent supportive housing locally, which really depends on each community’s supply and availability. Some communities with a large supply of permanent supportive housing can make significant progress towards the goal just by improving the targeting of existing units. Most communities will also need to create new supportive housing through both targeted grants and mainstream resources.

It is truly an honor to have this opportunity to serve as Executive Director of the U.S. Interagency Council on Homelessness (USICH) and to help carry forward the great work of this agency and of my predecessors. It is also a distinct privilege to work with the fantastic team of staff we have at USICH, both the team working here in DC and our Regional Coordinators working out in the field. Finally, I am humbled by the many sacrifices that my husband, Dean Thorp, is making so that I can step into this role.

USICH’s work is successful because of our strong partnerships with other Federal agencies and their incredibly committed leaders and staff, and because of the collaborative efforts of dedicated people working in states and local communities. Together, we are at a critical point in our efforts to prevent and end homelessness in the United States; we’ve made unprecedented progress and can point to substantial accomplishments under all of the objectives within Opening Doors, but clearly there remains much more work to be done. While we have seen significant reductions in the numbers of people experiencing homelessness documented through the annual Point-in-Time (PIT) count, the fact that the 2014 PIT count identified 578,424 people experiencing the crisis of homelessness, and other data such as from HUD’s Worst Case Housing Needs report, serve as a staunch reminder that housing affordability, housing instability, and homelessness continue to be national challenges—challenges that we must and can successfully address.

As described in Opening Doors, our focus is on ending homelessness for all populations, and we must seize this historic opportunity to expand housing for every child, youth, family, and individual struggling to achieve stability within our communities.

I was happy to welcome U.S. Secretary of Labor Thomas Perez to Tucson earlier this year for our annual Point In Time Count, also known as the Street Count. The Street Count helps communities determine service needs by interviewing their homeless population. That information is then forwarded to our federal partners, who use it to allocate resources. At the Street Count, volunteers and staff from government and social service agencies canvass – in Tucson’s case, the surrounding desert – as well as underpasses, culverts, shelters, soup kitchens, and other areas where folks experiencing homelessness are known to gather.

Not every mayor meets a member of the President’s cabinet wearing blue jeans and hiking boots, but then, homeless camps in the desert are a far cry from Capitol Hill. Secretary Perez arrived at our meeting place ready to work. After talking with some of the other canvassers, we headed out to a camp about 20 minutes away, on the southeast side of Tucson.

I was proud to stand with Connecticut Lieutenant Governor Nancy Wyman to support the March 9 launch of Connecticut’s 100-day effort across four communities to accelerate efforts to end homelessness. This exciting 100-day effort was brought together by the Connecticut Coalition to End Homelessness and Journey Home of Hartford. The Connecticut-based Rapid Results Institute, which developed the “100-Day” rapid results approach and has led similar efforts across the nation to successful outcomes, will facilitate. It is clear that Connecticut is successfully building its organizing efforts across the state that will feed momentum toward ending Veteran homelessness by 2015 and chronic homelessness by 2016.

Connecticut has mobilized advocates, activists, and service providers, together with support from state and federal officials, to forge new ways to coordinate and use existing resources more effectively to end homelessness in their communities. The HUD Field Office, led by Suzanne Piacentini, has been a key partner along with Dr. Laurie Harkness of the VA’s Errera Community Care Center. The Connecticut effort is a stand-out model, the first statewide implementation of the Rapid Results approach, with nearly the entire state participating. Participating communities include Greater Hartford, Fairfield County, and eastern Connecticut. Last year, a similar effort in New Haven led to the housing of 160 people who had long been experiencing homelessness in that community. In less than six months, this effort decreased that city’s chronically homeless population by more than 75 percent.